Bullous Pemphigoid is typically characterized by which combination of findings?

• A. Tense bullae that do not rupture easily
• B. Positive Nikolsky sign
• C. Mucosal involvement is common
• D. Rapidly spreading vesicular eruption

Answer: (A)

In bullous pemphigoid, the blistering is subepidermal, so the blisters are tense and sit securely on the skin rather than being flaccid. This makes them less prone to rupture, which is why tense bullae that do not rupture easily are the characteristic finding. The autoimmune attack targets the basement membrane, so the separation occurs beneath the epidermis, not within it, explaining the intact, robust bullae. A positive Nikolsky sign is not typical because the surface epidermis remains attached when gently rubbed. Mucosal involvement is not the common feature here, though it can occur rarely; when it does, it’s usually less prominent than in other blistering diseases. Rapidly spreading vesicular eruption is also not characteristic, as the lesions tend to appear in crops over time rather than spreading quickly.